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Question 1 of 5

The client at 38 weeks gestation is admitted with a blood pressure of 150/100,proteinuria and edema. The nurse should prepare to administer which of the following medications?

Correct Answer: A

Rationale: The client’s symptoms (hypertension proteinuria edema) indicate preeclampsia. Magnesium sulfate is administered to prevent seizures (eclampsia). Terbutaline is a tocolytic hydralazine treats hypertension and betamethasone is for fetal lung maturity in preterm labor.

Question 2 of 5

The nurse caring for a client receiving intravenous magnesium sulfate must closely observe for side effects associated with drug therapy. An expected side effect of magnesium sulfate is:

Correct Answer: B

Rationale: Hypersomnolence (drowsiness) is an expected side effect of magnesium sulfate used for preeclampsia due to its central nervous system depressant effects. Absence of reflexes or decreased respiratory rate would indicate toxicity not an expected effect.

Question 3 of 5

A psychotic client who believes that he is God and rules all the universe is experiencing which type of delusion?

Correct Answer: B

Rationale: These delusions are related to the belief that an individual has an incurable illness. These delusions are related to feelings of self-importance and uniqueness. These delusions are related to feelings of being conspired against. These delusions are related to denial of self-existence.

Question 4 of 5

At 12 hours postvaginal delivery, a female client is without complications. Which of the following assessment findings would warrant further nursing interventions?

Correct Answer: B

Rationale: Bradycardia of 50-70 bpm may be considered normal postpartally because the heart compensates for the decreased resistance in the pelvis. The uterus is displaced from the midline by a full bladder. This condition could lead to a boggy uterus and increased risk of postpartal hemorrhage; therefore, the bladder should be kept empty. Re-establishment of normal bowel function is delayed into the first postpartum week. A postpartum woman's oral temperature may go as high as 100.4°F within 24 hours of delivery resulting from muscular exertion, dehydration, and hormonal changes.

Question 5 of 5

A 35-year-old primigravida comes to the clinic for her first prenatal visit. The midwife, on examining the client, suspects that she is approximately 11 weeks pregnant. The pregnancy is positively confirmed by finding:

Correct Answer: B

Rationale: Chadwick's sign is a presumptive sign of pregnancy. The coloration may not subside from past pregnancy or could be caused by other situations that create vasocongestion. FHR (movement) observed DISTINCT on ultrasound is a positive diagnosis of pregnancy. Enlargement of the uterus may be due to fibroids or infection. It is considered a probable sign. Breast tenderness and enlargement is a presumptive sign because it may be due to other conditions, such as premenstrual changes.

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